Just because it’s nonprescription doesn’t mean it’s harmless, experts caution in wake of teen track star’s overdose from sports cream

From HealthDay

The bizarre death of a New York City high school track star from a muscle pain cream overdose is raising a red flag once again on the hazards of overusing common over-the-counter medications, experts say.

The New York City medical examiner’s office ruled last week that 17-year-old cross-country runner Arielle Newman died from an accidental overdose of methyl salicylate, the wintergreen-scented ingredient found in popular sports balms.

To help ease exercise-related discomfort, the Staten Island teenager reportedly had been putting Bengay on her legs between running meets, while also using adhesive pads with methyl salicylate, an aspirin-like anti-inflammatory, and a third product, according to the Associated Press.

“There were multiple products, used to great excess,” Ellen Borakove, a spokeswoman for the NYC medical examiner’s office, told the AP. All of the products can be found as nonprescription items on drug store shelves.

But over-the-counter almost never means “harmless,” experts warned.

Methyl salicylate, or salicylic acid, is the active ingredient in creams such as Bengay, Icy Hot and Tiger Balm, as well as aspirin, and “is potentially harmful if it is overused,” said Dr. Gerard Varlotta, the director of sport rehabilitation at Rusk Institute of Rehabilitation Medicine in New York City.

An anti-clotting agent, salicyclic acid at very high doses “can cause internal bleeding, it can cause arrhythmias of the heart, it can cause problems in the liver — there are any number of ways it can get to you,” Varlotta added.

However, long-familiar brands like Bengay (which first debuted in U.S. drug stores more than 100 years ago) don’t set off alarm bells in most Americans’ minds, so the temptation to overuse them is there, Varlotta said.

And while most people would definitely think twice about swallowing a fistful of aspirin or other OTC pills, people forget that creams carry dangers, too.

“Remember, there are a whole variety of [medicinal] products that are specifically formulated to be absorbed through the skin,” Varlotta said.

As with any drug, moderation is key, another expert added.

“You have to follow the directions, because the poison is in the dose,” advised Elena Juris, an education outreach specialist at the American Association of Poison Control Centers in Washington, D.C. And that maxim applies to creams just as much as it does to pills, she said.

Her groups’ statistics for 2005 show that 14 Americans died from skin exposures to some kind of toxic substance, although a breakdown on exactly which substances caused those deaths has not yet been compiled, Juris said.

However, she noted that, “the seventh most common substances involved in human exposures from poisoning are, in fact, topical preparations. In 2005, poison control centers reported 109,831 exposures related to topical substances.”

Newman’s Bengay-linked death was an extremely rare occurrence, however, and Johnson & Johnson, which makes the cream, told AP that their product “is safe and effective when used as directed to provide relief from minor arthritis pain, sore, aching and strained muscles and backaches.”

Similar to advice given for prescription drugs, it’s crucial that consumers carefully read label instructions and warnings for all OTC products. Varlotta believes that the cautions could be better highlighted, however.

“If you look at all of these [OTC] products, you cannot tell anything from the outside of the box,” he said. In the case of the Bengay that Newman used, “there’s nothing in big letters that says that it contains aspirin,” Varlotta said. “It’s in the fine print.”

Many consumers also fail to realize that the same drug can pop up in multiple, and very different, OTC products.

“Cough and cold preparations are a common mistake,” Juris said. “You might be taking a cold preparation that includes acetaminophen, and you also take acetaminophen [pills] for headache. So, you are overdosing it right there. So, it’s not just looking at the label for directions, it’s also making sure that you are not combining products and increasing the recommended dosage.”

Other OTC products on Varlotta’s radar include the painkillers Advil or Motrin (two or three OTC pills equal the dose in one prescription-strength pill, he noted), a host of poorly regulated herbals and dietary supplements, and Voltaren, an anti-inflammatory muscle cream that many of his patients bring back with them from Europe.

Voltaren isn’t approved for OTC sale in the United States, Varlotta said, but it can cause real problems for Americans who bring it home.

“People come back, and they are given a prescription by their doctor for another anti-inflammatory, so that means they’re now using the cream plus the anti-inflammatory, and they end up getting gastrointestinal problems, bleeding,” he said. “And then I tell them: ‘Let me see the cream.’ And sure enough, it’s Voltaren or some other cream they’ve brought back.”

The bottom line, according to the experts, is that every drug — even a nonprescription cream — comes with some level of risk.

“Just because it’s OTC doesn’t mean that it’s entirely safe and that it can be used against the directions that are being set out by the makers,” Varlotta said. “People should know what they are taking, both orally and on their skin.”

More salads, exercise, can keep lung tumors at bay, one study found

From HealthDay

While genes and environment can affect your risk for cancer, so can everyday lifestyle choices on things such as diet, exercise and smoking, new research shows.

The findings were to be presented Friday in Philadelphia at an American Association for Cancer Research conference on cancer prevention.

One study found that people who quit smoking can further reduce their risk of lung cancer by eating plenty of vegetables (four or more servings of salad a week or equivalent). The researchers at the University of Texas M.D. Anderson Cancer Center also found that former smokers who get exercise through gardening are 45 percent less likely to get lung cancer than former smokers who don’t garden.

Current smokers who ate three servings or less of salad a week were two times more likely to develop lung cancer than current smokers who ate four or more salads a week. Current smokers who gardened were 33 percent less likely to get lung cancer than current smokers who didn’t garden, the Texas team found.

“Although this is a very preliminary analysis, it give us some important clues about how everyone — smokers and non-smokers alike — might be able to reduce their risk of developing lung cancer,” Michele Forman, a professor of epidemiology at the University of Texas, said in a prepared statement.

“If you are worried about lung cancer risk, this study shows that you may benefit from eating a healthy diet and being physically active,” she said.

A second study suggests that males may be more prone to developing cancer than females because of gender differences in antioxidant levels and the ability to repair DNA damage.

The Ohio State University study found that the same degree of damaging ultraviolet (UV) light caused more damage to the skin of male mice than to that of female mice. As a result, the male mice developed more squamous cell skin cancers, and these tumors grew more quickly and aggressively than the same type of tumors on the skin of female mice.

The findings may help explain why men develop three times as many squamous cell skin cancers than women and why men are more prone to developing cancer in general, the researchers said.

“Men get more skin cancer than women, and it has classically been thought that the reason for this is lifestyle — men spend more time outside and are less likely to use sun protection,” Kathleen Tober, a research scientist in OSU’s pathology department, said in a prepared statement. “Our data suggests that while that may be a factor, an even more critical reason for this difference is that female skin may be better able to combat the damaging effects of UV exposure.”

“Based on our data, it would be a reasonable hypothesis that one of the underlying mechanisms for this is that men might have less overall antioxidant levels and diminished DNA repair capacity,” Tober said.

A third study found that black Americans may have a more difficult time giving up smoking, because they have much lower levels of an enzyme (glucuronide) that metabolizes nicotine and nicotine byproducts than whites. This means that blacks may experience higher nicotine levels when smoking, which makes it more difficult for them to kick the habit.

“Smokers adjust their level of smoking to maintain blood levels of nicotine, which are determined in part by rates of nicotine metabolism, and, while we can’t say from this study that differences in metabolism definitively account for lower quit rates (among blacks), it could very well have an impact,” Jeannette Zinggeler Berg, an M.D./Ph.D. student in biochemistry, molecular biology, and biophysics at the University of Minnesota, said in a prepared statement.

From USATODAY.com

Thirteen states don’t have adequate plans to distribute vaccines and antidotes in the event of a flu pandemic or a bioterrorism attack, according to a health preparedness report out Tuesday.

The Trust for America’s Health, a non-partisan research organization, found that states have made significant progress in preparing for major health emergencies since 9/11 and the anthrax attacks of 2001. But large gaps in readiness still exist, the report said.

“Emergency health preparedness is on the national radar, but until all states are equally well prepared, our country is not as safe as it can or should be,” said Jeff Levi, director of the Trust.

The Trust used 10 indicators to rate a state’s preparedness. They ranged from the state’s ability to distribute drugs from the national stockpile to whether the state uses a disease surveillance system that’s compatible with the government system at the federal Centers for Disease Control and Prevention (CDC) in Atlanta.

Seven states got a perfect score: 10 out of 10. Six were at the bottom of the spectrum, scoring six out of 10.

FIND MORE STORIES IN:Centers for Disease Control and Prevention | Emergency | Flu | Irwin Redlener

Among the findings outlined in the report:

Flu vaccination rates decreased among the elderly in 11 states during the past year.

Seven states and Washington, D.C., lack sufficient capacity to test for biological threats.

21 states don’t give liability protection to health care workers who volunteer during emergencies.

Six states cut their public health budgets between fiscal 2005 and fiscal 2006.

Seven states haven’t joined a federal program to buy lower-cost antiviral drugs.

Richard Besser, director of Terrorism Preparedness and Emergency Response at the CDC, said states have made tremendous strides in the past five years. In the 13 states that don’t have plans to distribute drugs from the stockpile, various creative approaches are being tested, he said.

Among them: Giving employers caches of drugs to distribute during a crisis and having postal workers deliver drugs house to house.

Long-term, Besser says he’s worried about how to keep emergency preparedness fine-tuned in the absence of an attack or a major outbreak.

“A well-working public health system is invisible to the community, but it’s absolutely essential,” he said.

Irwin Redlener, associate dean of Public Health Advocacy and Disaster Preparedness at Columbia University’s Mailman School of Public Health, said he’s particularly concerned about hospitals and their ability to deal with sudden surges of large patients during a disaster.

“Hospitals have become way stations for the millions of Americans that don’t have health care, so emergency rooms already are overcrowded,” Redlener said.

“I shudder to think what would happen in the event of a large-scale disaster.”